This precare document is designed to give you information about the procedure, including what to expect, how to prepare, and the potential risks and benefits. If you have any questions after reading this, please don’t hesitate to contact us.
Indications
Botulinum toxin is licensed for the temporary improvement of moderate to severe lateral canthal lines (crow’s feet at the outer corner of the eyes), glabellar lines (frown lines between the eyebrows) and horizontal forehead lines. There are other areas which are less commonly treated with botulinum toxin. Although this is “off label” (not specifically licensed for this treatment), these are well established and have evidence to support their use.
Examples of these areas include: gummy smile, bunny lines, lipstick lines, platysmal bands (neck), pebbled chin, drooping corners of mouth, brow lifting and hyperhidrosis (excessive underarm sweating).
How it works
Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium Botulinum. There are many brands available in the UK which include Azzalure®, Botox®, Xeomin®, Dysport® or Bocouture®. All brands are prescription only medications.
Botulinum toxin is injected, using a fine needle, into the target muscle to temporarily block the nerve signal, resulting in weakening of the muscle action which can result in an improvement in the appearance of lines of facial expression. Botulinum toxin can only treat lines of expression (dynamic lines). Lines that are present when the muscle is not contracted, and the face is relaxed (static lines), generally do not improve with these injections. It is not always possible or desirable to stop all movement.
What are the side effects?
Millions of botulinum toxin treatments have been performed worldwide and it has an excellent safety profile. However, as with any medical aesthetic procedure, there are certain risks and side effects that you must be aware of.
Botulinum toxin involves tiny injections into the skin and is minimally uncomfortable. Small pin-pricks or little pink bumps may be visible immediately after treatment, but typically disappear by the time you go to bed the same night. Occasionally a small bruise may appear at one of the injected sites.It is not unusual to experience a heavy sensation or headache after your treatment. This is more common when first having treatment, but some people experience it each time. It is okay to take paracetamol to relieve this when it happens, if you are normally okay with paracetamol.
In patients with darker skin types, injections can sometimes leave areas of darker pigmentation. Infection is another possible injection-related side effect.
Occasionally nausea, facial pain, eye pain, visual disturbance and flu-like symptoms have been reported.
In some cases (despite correct injection technique) the active ingredient can unintentionally migrate into nearby muscles and cause an unwanted weakening of these. This may lead to a ptosis (drooping or lowering) of the eyelid and/or eyebrow or difficultly smiling/ drinking/ kissing. These are temporary side effects, which will resolve fully, however this might take some weeks to months. In cases of eyelid drooping, certain prescription eye drops might help.
Please note that when treating the forehead, we unfortunately cannot treat lines 1– 2 cm above the sides of the eyebrows, as this carries a higher risk of unwanted drooping. In very few cases the eyebrows can temporarily appear pointed/ with an unnatural appearing angle (‘Spock eyebrows’). Asymmetric results are also an occasional problem. In extremely rare cases, difficulty breathing or swallowing (with potential for pneumonia due to unwanted food/ liquid in the airways) have been reported. Please seek immediate medical attention if you develop breathing, swallowing or speech problems.
If an anaesthetic cream has been used, there is the possibility of an allergic reaction to this.
Treatment results are often more successful when the skin is in good condition, with good elasticity, where facial expressions are not excessive and there are no or minimal static lines in the areas to be treated.
How quickly does it work?
The effects of Botulinum toxin are not instantaneous. You may start to notice some changes within 3-5 days of your treatment and you will have a good idea of the final result by 2 weeks. Botulinum toxin may work on some muscles before others so it is advisable to wait for this period of time before arranging a review if you think you need any adjustment.
How long does it last?
Typically, the effects wears off gradually after treatment over a 3 month period. Treatment can be repeated to maintain the desired results and most people require this approximately 4 x per year. It is not recommended to repeat treatments at intervals of less than 3 months.
Will I look worse if I stop having Botox?No. You will just return to your pre-treatment condition.
Please note that you may not be suitable for treatment if any of the following apply and you must let the doctor know before attending your appointment:Are there any precautions I should take?